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Recurrence patterns identify aggressive form of human papillomavirus-dependent vulvar cancer

McWhirter, RE ORCID: 0000-0002-9409-8074, Otahal, P ORCID: 0000-0003-4042-1769, Taylor-Thomson, D, Maypilama, EL, Rumbold, AR, Dickinson, JL ORCID: 0000-0003-4621-1703, Thorn, JC, Boyle, JA and Condon, JR 2019 , 'Recurrence patterns identify aggressive form of human papillomavirus-dependent vulvar cancer' , Australian and New Zealand Journal of Obstetrics and Gynaecology , pp. 1-7 , doi: 10.1111/ajo.13075.

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Background: Vulvar cancer is rare and, as a result, is understudied. Treatment ispredominantly surgery, irrespective of the type of vulvar cancer, and is associatedwith physical, emotional and sexual complications. A cluster of humanpapillomavirus (HPV)-dependent vulvar cancer patients was identified in ArnhemLand Northern Territory (NT), Australia, in which young Indigenous women werediagnosed at 70 times the national incidence rate.Aims: To assess whether women from the Arnhem Land cluster differ from womenwith vulvar squamous cell carcinoma (VSCC) and vulvar intraepithelial neoplasia(VIN) resident elsewhere in the NT in recurrence after treatment, diseaseprogression and mortality.Materials and methods: A retrospective cohort study of NT-resident womendiagnosed with VIN or invasive vulvar cancer (VSCC) between 1 January 1993 and30 June 2015 was undertaken. Time to recurrence was assessed using cumulativeincidence plots and Fine and Gray competing risk regression models. Meancumulative count was used to estimate the burden of recurrent events.Results: Indigenous women from Arnhem Land experienced more recurrencesafter treatment than non-Indigenous women, the cancers recurred faster, andIndigenous women have worse survival at five years.Conclusions: In characterising the epidemiological features of this cluster, wehave identified a particularly aggressive form of vulvar cancer. This provides aunique opportunity for elucidating the aetiopathological pathways driving vulvarcancer development that may ultimately lead to preventive and therapeutic targetsfor this neglected malignancy. Further, these findings have important implicationsfor clinical practice and HPV vaccination policy in the affected population.

Item Type: Article
Authors/Creators:McWhirter, RE and Otahal, P and Taylor-Thomson, D and Maypilama, EL and Rumbold, AR and Dickinson, JL and Thorn, JC and Boyle, JA and Condon, JR
Keywords: vulvar cancer, VIN, Aboriginal and Torres Strait Islander health, HPV
Journal or Publication Title: Australian and New Zealand Journal of Obstetrics and Gynaecology
Publisher: Wiley-Blackwell Publishing Asia
ISSN: 1479-828X
DOI / ID Number: 10.1111/ajo.13075
Copyright Information:

Copyright 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

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